Cor et Vasa Case Reports 3/2021


titulka_ico.jpgCor et Vasa Case Reports
Ročník | Volume 4 • Číslo | Number 3
Listopad | November 2021

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Kardiální sarkoidóza, myslíme na ni v diagnostice? 

N. Vahančíková, A. Linhart, T. Grus, T. Adla, K. M. Plocová

Sarcoidosis is a rare systemic inflammatory disease, with multiorgan involvement and the exact cause of sarcoidosis is unknown. The most commonly affected are lungs, skin or lymph nodes. Extrapulmonary involvement is less common. Especially cardiac sarcoidosis (CS) has variable clinical manifestations, causing heart failure (HF), arrhythmias, and involvement of pericardium. Diagnosis of cardiac sarcoidosis depends on more complex imaging methods such as myocardial magnetic resonance imaging (CMR) and positron emission tomography (PET/CT). In addition to standard cardiology procedures, corticosteroid therapy or other immunotherapy should be considered.

Útlak koronární tepny jako příčina akutní ischemie myokardu 

S. Lietava, T. Ondrúš, R. Štípal, M. Hetmer, P. Lokaj, J. Pařenica, P. Kala

Acute coronary syndrome such as myocardial infarction with ST elevations on the ECG, is mostly caused by thrombotic coronary artery occlusion. In rare cases, extracardiac disease can be a cause of myocardial ischemia. We present a case of a patient admitted to our department with typical chest pain and ST elevation on the ECG. Urgent selective coronary angiography proved an alteration in the flow of the periphery of the coronary artery by compression from outside. By echocardiography we detected tumorous mass in the pericardium as the cause of myocardial ischemia. Primary origin was cancer of the lower lobe of the left lung. Final diagnosis was myocardial infarction type 2.

Ascites a suspektní cirhóza jater jako dominantní příznaky syndromu efuzivně konstriktivní perikarditidy 

M. Brabec, M. Radvan, M. Hudec, M. Šišáková, P. Vysočanová, R. Štípal, M. Šebo, V. Zvárová, L. Kunovský, D. Nešpor, P. Kala

Effusive-constrictive pericarditis (ECP) is a relatively rare disease. Frequent primary involvement of the gastrointestinal tract makes the diagnostic process complicated and delays therapy initiation. We describe the case of a 41-year-old man, initially managed for a long time by a gastroenterologist in an outpatient clinic, presenting with a newly detected ascites and pericardial effusion caused suspiciously by liver cirrhosis. Ultimately, the development of a cardiac tamponade required thoracoscopic pericardial fenestration. The pathology report of pericardial biopsy combined with transthoracic echocardiography (TTE) findings of pericardial constriction led to the final diagnosis of ECP. An acceptable regression was not achieved despite the uttermost pharmacological treatment and the patient finally had to undergo pericardiectomy.

Akutní infarkt myokardu s elevacemi úseku ST a primární fibrilací komor u pacienta s hemofilií A těžkého stupně 

V. Poštulka, T. Jandčárková, P. Salaj, J. Knot, M. Kozel, J. Ulman, Z. Moťovská

Coincidence of patients with haemophilia (PWH) and acute myocardial infarction (AIM) is still rare even with prolonging life expectancy. Treatment of this specific population group is especially challenging when considering an acute clinical setting of STEMI. Rare occurrence, insufficient experience, and lack of evidence from randomised trials highlight the importance of reporting and presenting such cases. Our case describes sixty-one-year-old patient with severe Haemophilia A presented with STEMI, complicated initially with primary ventricular fibrillation. Description of antithrombotic treatment and concurrent haemosubstitution required for performing primary PCI is demonstrated. In the presented case, urgent cooperation of a cardiologist and a haematologist was carried out.